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OBJECTIVE:

To describe how simulated apical support affects the appearance of prolapse in the anterior and posterior vagina using a modification of the Pelvic Organ Prolapse Quantification (POP-Q) examination.

METHODS:

Women with prolapse stage II or greater were examined using the POP-Q. To simulate apical support, the posterior blade of a standard Graves speculum was positioned over the posterior vagina to support the vaginal apex while remeasuring points Aa and Ba and over the anterior vagina to support the apex while remeasuring points Ap and Bp. Change in anterior and posterior POP-Q points and prolapse stage with apical support were calculated.

RESULTS:

One hundred ninety-seven women were enrolled with mean age of 62±14 years, median parity of 2 (range 0–8), and mean body mass index of 28±5 kg/m 2. By standard POP-Q, 36% had stage II prolapse, 54% had stage III, and 10% had …